Provider Demographics
NPI:1871195495
Name:NGO, KENNY VU (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KENNY
Middle Name:VU
Last Name:NGO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15612 SAIL ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-5332
Mailing Address - Country:US
Mailing Address - Phone:714-260-1197
Mailing Address - Fax:
Practice Address - Street 1:222 N MARKET ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1217
Practice Address - Country:US
Practice Address - Phone:310-677-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist